Tuesday, 9 March 2010

Health times: Diabetes is more than the sugar blues

Health times: Diabetes is more than the sugar blues

I was getting that deer-in-the-headlights, open-mouthed look as I reviewed Mrs. Brown's lab results. It's not as dreadful as telling someone that they have cancer, but a diabetes diagnosis almost always triggers that look of disbelief and distress.

Happily, Mrs. Brown moved past that to a look of determination, asking, “So what can I do about this? I don't want to be on medicines unless I have to. I normally eat well and walk regularly. But I've had a knee injury that's been dragging on for months. So I've been doing almost no exercise and I've packed on about 20 extra pounds.”

It seems like these conversations are more and more frequent in my practice. Tennessee ranks sixth among the 50 states for prevalence of diabetes. It is no coincidence that we also rank fourth in obesity with over 30 percent of our adults being obese. Even though genetics plays a role, type 2 diabetes (often called “adult onset” or “non-insulin-dependent” diabetes) is closely tied to obesity and a sedentary lifestyle — two factors that increasingly describe a large portion of our population. Ninety percent of all diabetes in the U.S. is type 2; almost 25 million people have it. It's estimated that a third of the cases are undiagnosed.

Wouldn't you know if you had it? Not necessarily. Mrs. Brown's reaction was not uncommon: “But I feel fine.” In the early stages of type 2 diabetes, there may be few symptoms: perhaps a little more frequent urination, increased thirst, occasional blurred vision, increased yeast infections. Often there may be no symptoms at all.

Yet the damage is beginning — damage that can result in permanent harm to the nerves, kidneys, vision and circulation, and eventually result in heart attacks, strokes, and occasionally, amputations.

So how do I find out if I have it? A simple blood test can do the job. A glucose tolerance test can be done. But more often the diagnosis is based on a fasting blood sugar greater than 125, a random blood sugar of 200 or higher, or a hemoglobin A1C (HbA1C) of 6.5 or higher.

HbA1C is a poorly named blood test. But it is exceedingly helpful; it reflects the previous three months of average blood sugars. So it can track whether your blood sugar is headed up or down. If you're headed toward a HbA1C of 6.5, that's a red flag.

But, if you have a HbA1C of 6.1, and for the next three months you exercise, eat well and shave off 10 pounds to lower it to 5.7, you've made excellent progress!

In diabetics, we generally get this test every three months to track how well their overall glucose (blood sugar) control is doing. In “pre-diabetics” (the official term is “impaired glucose tolerance”), I also check it every few months to monitor how a patient's diabetes prevention efforts are doing and, worst case, to at least make an early diagnosis and begin treatment if they moved into diabetes. And speaking of prevention and treatment, let's dig into that next time — there's lots of hopeful possibilities there.

Dr. Andrew Smith is board-certified in family medicine and practices at 1503 E. Lamar Alexander Parkway, Maryville.

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